Battered child syndrome (BCS)
Introduction
Battered child syndrome refers to non-accidental injuries sustained by a child as a physical
abuse, usually inflicted by an adult caregiver. Battered child syndrome is any act of physical,
sexual or psychological aggression, negligence or intentional neglect a minor.
Incidence
According to one estimation; approximately 2.9 million cases of child abuse are reported each
year worldwide, in 2012 ,80% of these committing the abuse were parents .Occasionally
abused kill one or both of their parents which is known as parricide. The total abuse rate of
children is 25.5 per 1000 children, with physical abuse accounting for 5.7 per 1000, sexual
abuse 2.5 per 1000, emotional abuse 3.4 per 1000 and neglect accounting 15.9 per 1000
children.
Causes/risk factor
Lower income
Psychological condition of parents
Incessant crying and whining
Perceived excessive fussiness and disobedient
A toddler failed toilet training
culture tradition
absused child
single parenthood
lack of education
alcoholism and other drug addiction
Sign and symptoms
Physical signs
Bruises that match the shape of hand, fist or belt
Cigarette burns; scald marks; black eyes
Unconsciousness
Lash marks; bruises or choke marks around necks; circle marks around wrists or ankles
(indicating twisting)
Separated sutures; unexplained unconsciousness ; and a bulging fontanel in small
infants
Poor performance in school
Lose weight or fail to gain weight appropriate to age
Emotional/psychological signs
A poor self-image
Sexual acting out
An inability to love or trust others
Aggressive, disruptive or illegal behavior
Anger more quickly ,cry more often
Show signs of clinginess
Anxiety, panic, and irritability
Self- destructive or self-abusive behavior
Suicidal thoughts
Passive or withdrawal behavior
Fear of entering into a new relationships or activities
Sadness or other problems of depression
Flashbacks or nightmares
Drugs or alcohol abuse
Diagnosis
Delayed visit to the emergency room with an injured child
An implausible explanation of the cause of the child’s injury
Repeated hospital visit and absurd complains by parents
Physical examination
X-ray, MRI ,CT,USG
Treatment
Medical treatment will vary according to the types of injury
Counseling and the implementation of an interventions plan
Placement of the child with an outside caregiver or returning the child to the home
Physical and psychological therapy
interventions counseling and training in good parenting skills
Pre hospital care
The initial statement of the mechanism of injury should be carefully documented.
In case of abuse ,the family may change the story and the initial history may become
critical
Observation and concern should be conveyed to the hospital personnel and Detail
description report should be written
Most importantly the emergency service provider must report to child protective services
when the abuse is suspected
Emergency department care
The initial medical treatment of the physically abused child in the emergency
department should proceed no differently from treatment of any injured child.
Initial assessment and treatment of the seriously physically abused child should
proceed according to established guidelines such as Advanced Life Support .Intra cranial
lesions should prompt neurosurgical consultation for management and decision for the
need of surgery. Such interventions should be guided by clinical examination CT scan
,and other investigations
Blunt abdominal trauma from child abuse should be identified quickly and treated
aggressively because of its attendant high mortality
All patients with suspected head injury should be kept in cervical precautions until the
spine is cleared
Documentation of the history and findings and report to the authorities
Policies for child protection
UNICEF works to improve the policies and service that protects all children. It aims to
make the world a safe place for children to thrive. The child protection programme aims
at preventing and responding to violence, exploitation, abuse and neglect of children,
including in emergency contexts.
The major results of the protection programme are given below;
Child protection system strengthening
State institutions and other partners have increases capacity to legislate, plan and
budget to prevent and respond to child protection concerns including during
humanitarian situations.
Prevention of violence and exploitation
Children, families/care givers, teachers, communities and state institutions have
improved knowledge, skills and capacity to prevent and respond to violence (violent
discipline, gender-based violence and child marriage)and exploitation .
Justice for child
Justice/security professionals and gender sensitive services to protect children in
contact with the justice system.
Achievement of these results will be measures through;
Less use of violent discipline(physical or psychological)
Less children engaged in child labor.
Less children living in residential care institution
More cases of violence against children reported to the police
More justice and security personnel capacitated on child friendly and gender sensitive
justice for children.
More community groups members trained on measures to prevent and respond to
violence and exploitation(violent discipline, child labor child trafficking and child
marriage)